EP Lab Digest - October 2007 - (Page 13)

OCTOBER SPOTLIGHT INTERVIEW We are not ACGME-approved for EP training. According to Dr. Dixon, “The discipline of cardiac EP has evolved over the years from a predominately diagnostic modality to a highly interventional diagnostic and curative modality of treatment. Given the complexity of the procedures, I feel that a two-year fellowship should be mandatory.” are very satisfied because of the level of sedation they receive during these extended procedures. Describe your city or general regional area. How does it differ from the rest of the U.S.? Hobart, Indiana is located in the northwest corner of the state, approximately 38 miles from Chicago. It is a growing community of newly developing subdivisions and industry. The area was historically built on the success of the steel mills that are located in the area. During the past 10 years, the steel industry has suffered greatly, which leaves many of our patients with issues of healthcare coverage. Because Indiana is not a certificate of need state, there are many freestanding hospitals and diagnostic and surgery centers within 10 to 15 minutes of our facility — including one right across the street. While many other smaller and community-based hospitals may have difficulty keeping up with larger competitors in their areas, St. Mary Medical Center and its sister hospitals of Community Healthcare System have grown strategically to bring in new technology, new procedures and new services, so patients do not have to travel great distances to get the very best in care. Together, the three hospitals of Community Healthcare System operate the region’s largest cardiovascular treatment program, with the electrophysiology lab at St. Mary Medical Center sharing its expertise and research studies with its two sister hospitals and vice versa. Figure 6. Martin Marquez, EP RT (left) and Melissa Schultz, RN (right) check emergency equipment in the EP lab of St. Mary Medical Center. Does your lab provide any educational or support programs for patients who may have additional questions or those who may be interested in support groups? We provide a support group for patients with implantable defibrillators.This group meets every two months.Topics of discussion include any new technology or treatment related to their devices, as well as pharmacological, nutritional and congestive heart failure information. Staff members assume responsibility for the set-up of the meetings (e.g., obtaining the speaker, planning refreshments, etc.). Sponsorship is sought from our device manufacturers. physician supervision. All are trained to do the basic interrogation of the devices we utilize. Changes to parameters are made only under physician order. An EP Cardiac Technician manages the transtelephonic pacing clinic as well as the LATITUDE/CareLink programs. They handle 50–60 device visits per week. PaceArt is used for the transtelephonic pacing program, and LATITUDE and CareLink are used for defibrillators. We tried doing RN-only checks, but the patients prefer to see physicians. With the advent of ICD remote monitoring, the physician sees the patient only twice a year, and the rest of the checks are done remotely. Pacing patients are also seen only twice a year. cardiologist, the knowledge base to adequately program, test and optimize these devices is not gained in a cardiology fellowship.There is no significant shortage of EP physicians in most areas, so this practice should be strongly discouraged!” What about device recalls? How has your lab handled these? We were impacted significantly by the device recalls over the past few years. We have followed the recommendation of the vendor for patient follow-up. Our physicians were very good about talking with patients about the various recalls. They provided needed reassurance to our patients, which resulted in greater patient understanding and acceptance of the information that was being broadcast by the media. Give an example of a difficult problem or challenge your lab has faced. How it was addressed? One of our biggest challenges was anesthesia services. During the complex, lengthy ablations, it was not suitable for a patient to receive intravenous sedation administered by the staff nurses, due to the prolonged nature of the cases and the limited number of meds that could be administered. Our in-house anesthesia department was unable to meet our needs with coverage — often dictating time of day/day of week, etc. that the cases could be done.This was not an acceptable situation to our physicians. St. Mary Medical Center recognized the need, and in order to solve the problem, contracted outside anesthesia services for utilization at St. Mary Medical Center and St. Catherine Hospital. The solution has worked well. Although this was a pricey solution, the benefits outweigh the cost.We have anesthesiologists who are available to us 24 hours a day. In addition, the working relationship with the group is impressive. These anesthesiologists are very familiar with every case we do in the department, including the level of sedation needed and the EP preferences.We started using them for all cases requiring a deeper level of sedation, such as biventricular and implantable defibrillator implants, cardioversions, NIPS and ablations.The anesthesiologists also follow us from one hospital to another. Of the utmost importance is our patient satisfaction. Patients What trends do you see emerging in the practice of electrophysiology? How is your lab preparing for these future changes? According to Dr. Mark Dixon, the Medical Director of our department, “Interventions will become increasingly complex and involve higher risk patients. The therapeutic technology will continue to evolve. St. Mary’s department has expanded to a two-lab facility, one for ‘simple’ cases such as pacemaker and defibrillator implants, tilts, cardioversions, NIPS and basic EP studies, and a second lab, known as the “interventional lab” for biventricular ICD implants and complex ablations. Our nurse manager works tirelessly to meet with hospital administration to budget for state-of-the-art upgrades and expansions.” Is your EP lab currently involved in any clinical research studies or special projects? Which ones? We have done research with both Guidant (Boston Scientific) and Medtronic over the past 10 years.We have participated in many clinical research studies involving leads/devices as well as post-market release studies. In the past, we participated in SCD-HeFT and COMPANION.We currently are involved with MADIT CRT. In addition, we are in the follow-up phases for the REASSURE AV Registry, EASYTRAK EP, EASYTRAK 3 Downsize, RENEWAL 3 AVT,APL and OMNI studies. Please tell our readers what you consider unique or innovative about your EP lab and staff. The most innovative and unique characteristics of our department are those of autonomy and standardization. This staff does it all! The staff are proficient at performing procedures and running the clinic at all three facilities. Procedures, policies, equipment and staff are standardized for the entire system. We even do our own internal registration of clinic patients so they can avoid waiting in the Admitting Department. We feel that there is a greater level of satisfaction among all involved because of these characteristics.We are providing a full-service EP program! For more information, please visit: www.comhs.org When was your last JCAHO inspection? Our last inspection was more than two years ago. We are expecting a visit early next year. What are your thoughts about non-EPs implanting ICDs? Do you train such individuals? Dr. Dixon writes,“I have a strong opinion against this practice.While the technical procedure is achievable by a good Are you ACGME-approved for EP training? What do you think about two-year EP programs? http://www.comhs.org

Table of Contents Feed for the Digital Edition of EP Lab Digest - October 2007

Finally! The New Registered Cardiac Electrophysiology Specialist (RCES) Credential: Interview with Christopher M. Nelson, RN, RCIS, FSICP ECG 101: Closing the Gap Phenomenon Contents Letter from the Editor ICD Patient Support Group: St. Peter’s Hospital Spotlight Interview: Community Healthcare System Use of Magnetic Catheter Navigation for Ablation of Focal Tachycardias Echocardiography: The Preeminent Front Line Screening and Diagnostic Tool for Cardiovascular Imaging and Physiological Assessment First Annual EP Lab Digest Salary Survey: Last Chance! Clinical Trial Update: 2007 Email Discussion Group Adopting and Implementing the AF Ablation Consensus Statement Electrophysiology in the West Summit Events Calendar The Sustained Treatment of Paroxysmal Atrial Fibrillation (STOP AF) Clinical Trial: Interview with Kevin Wheelan, MD Industry News and Products

EP Lab Digest - October 2007

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